Can we recognize clinical parameters which are associated with occurrence and severity of graft-versus host disease?

Abstract

The application of allogeneic hematopoetic stem cell transplantation (HSCT) is limited by life-threatening complications such as severe or acute graft-versus-host disease (GVHD). Despite intensive prophylaxis with immunosuppressive agents, the incidence of GVHD occurs in 9-50% of patients undergoing transplant with an identical HLA sibling matched donor and 75% of patients undergoing unrelated HLA donors. Aim of study: To evaluate our experiences in GVHD prophylaxis and treatment after alloTHSC, GVHD incidence and prognostic factors and administration of new immunosuppressive regiments. Patients and methods: Starting from September 2000 till September 2009, 63 patients (36 males and 27 females) at the age of 16-56 (median range 33 years) with hematological malignances were treated with alloTHSC on Department of Hematology, Clinical Centre, and Skopje. For 55 patients donors were HLA identical siblings and the rest 8 patients were transplanted from HLA unrelated donors. In 10 patients bone marrow was used as source of stem cells and in 53 patients stem cells were obtained from peripheral blood. From the group of 63 patients, 26 patients have active disease at the time of transplantation. GVHD prophylaxis was accomplished with combination of cyclosporine and metothrexate (Seattle regimen) or more intensive immunosupression regiments. Results: GVHD was noticed in 30 patients (47,6%) and at 33 patients (52,4%) was not noticed a manifestation of GVHD. Acute GVHD was noticed in 24 patients (38%) and chronic GVHD in 20 patients (31,7%) The remaining 32 patients (45%) achieved complete clinical and hematological remission. Lethal outcome was confi rmed in 31(49%) patients (9 from chrGVHD,6 from acute GVHD, 16 from disease relapse). Conclusion: The incidence of acute GVHD in our study was 38% and 31% of chronic GVHD. The most common GVHD reaction was registered in female donors and male recipients, with higher GVHD incidence in elderly patients. In all patients stem cells were obtained from peripheral blood. Active disease, sex, source of hematopoetic cells, age and conditional regiments are the most signifi cant predictive factors with the higest infl uence of incidence of GVHD.